The FDA has approved Opvee, which can reverse fentanyl and other opioid overdoses.
Every two weeks, Abby Hampton gets a delivery to her home in rural Amboy, a little more than 100 miles west of Chicago’s Loop.
On a recent Wednesday, she was able to choose from the supplies neatly packed into a minivan run by an organization called The Perfectly Flawed Foundation: syringes, boxes for used needles, fentanyl testing kits, the overdose reversal drug naloxone, alcohol wipes, shampoo and gum.
Hampton said since she doesn’t have to buy her own syringes, “I can just switch out every time I use now.” While she’s been off heroin for eight years, she continues to use drugs including cannabis and occasionally methamphetamines, she said. A friend introduced her to Perfectly Flawed two or three years ago, she said.
“I definitely think that there’s a lot of people you’re not going to get to go into recovery, so putting forth some effort into trying to keep it as safe as possible, and making it easier for us to be safe about it, and cleaner and all that — it’s definitely a big deal,” Hampton said, wearing bedazzled wraparound sunglasses in the yard of her three-flat apartment complex.
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Perfectly Flawed’s services are part of a growing community-based harm reduction approach to drug addiction and overdoses, helping Hampton and others who use drugs across a wide swath of Illinois avoid reusing needles, unintentionally ingesting fentanyl and dying from overdoses.
Matt Rowlee, right, an outreach specialist with the Perfectly Flawed Foundation, delivers harm reduction and overdose prevention supplies to Abby Hampton on Sept. 4, 2024, in Amboy, Ill.
Armando L. Sanchez, Chicago Tribune
Organizations providing those services often operate on shoestring budgets from private and government funding, and struggle to keep up with the demand as the nation continues to suffer from tens of thousands of opioid overdose deaths per year.
Now, groups in Illinois providing harm reduction services are set to receive at least $15 million from settlements between states and prescription drug companies.
Providers across the state say they could do much more with additional funding, but getting money from the remediation fund is complicated.
“Unrestricted settlement dollars could really — I mean, there needs to be an investment in harm reduction supplies across the state of Illinois. People are desperate for them,” John Werning, executive director of the Chicago Recovery Alliance, said.
Settlements from multistate agreements with prescription painkiller manufacturers, distributors and sellers have put Illinois in line for well over $1 billion in payouts to help with the crisis.
Of more than $115 million that’s been allocated from the fund, $15 million over three years has specifically been set aside for harm reduction services. None of that money has gone out yet, according to a state-run dashboard last updated in May, though at least one organization said it has been granted some funding through a different allocation.
Much of the rest of the money is still being sorted out through a complex bureaucratic process overseen by a number of entities intended to make sure it’s used responsibly.
Nationwide, more than $50 billion is expected from the settlements. Other states have used the funds for syringe exchange programs, treatment centers and supporting law enforcement.
Perfectly Flawed, for its part, would use the money to expand from a minivan to something bigger, founder and executive director Luke Tomsha said. That upgrade could allow for more privacy in discussions, medical care or drug testing, he said.
Rural and city problem
The overdose problem has a hold in many rural areas and is especially acute in some Chicago neighborhoods. The West Side is home to some of the highest overdose rates in the state, the Illinois Department of Public Health said in 2020.
“Next to the gun violence, this may be the number one problem on the West Side of Chicago,” state Rep. La Shawn Ford said. The Democratic lawmaker has supported harm reduction and recovery efforts in his district, including pushing legislation for an overdose prevention site, where people could use drugs in a supervised setting on the West Side.
One local organization trying to deal with that crisis has set up a mobile shower unit distributing harm reduction supplies and said it would use additional funds for a drop-in location and case management services.
While advocates credit the state for making harm reduction a priority in its ideals for addressing the crisis, smaller organizations without much administrative infrastructure say they’re worried about being able to win grants and feel they are at risk of losing out to larger rehabilitation and recovery-based groups.
And a wide range of organizations have raised concerns about the speed at which the massive settlements are being distributed.
Werning of the CRA believes the settlement money is relatively unrestricted — compared with federal funds, for example — and could be used for a wide range of services. But exactly how it will be used is unclear, because little has gone out so far to organizations like his, he said.
“It’s such a complicated system, and it doesn’t seem to me like they’re prioritizing harm reduction at all, so we keep funneling more money into the same type of interventions we’re always, we’ve always funneled money towards, so it’s a disheartening process to say the least,” Werning said.
A spokesperson for the Illinois Department of Human Services, the state agency most directly involved with overseeing the allocation of the remediation fund, noted in a statement that harm reduction “is a priority for the State as outlined in the State Opioid Action Plan,” a document that sets priorities for mitigating the crisis.
Werning said the Chicago Recovery Alliance is the oldest opioid education and naloxone distribution organization in the country. But it still doesn’t receive much government funding for harm reduction supplies, he said.
The CRA, which mostly serves the South and West sides, has about a dozen employees, including some that are part time, he said, and could reach more people with more staff and supplies.
A minivan is the main office for Matt Rowlee, an outreach specialist at Perfectly Flawed who delivers supplies to Hampton’s home. The organization is based in a converted train station in La Salle, sandwiched between the rural town’s main street and the tracks, just a few miles from Starved Rock State Park. The group offers walk-in services and support groups at this location, but the van offers a solution for people who don’t drive in an area with few public transit options.
Wide delivery area
On a recent day, Rowlee took the van to at least three locations some 20 or 30 minutes apart. In tiny La Moille, population about 700, a school wanted a delivery of naloxone to keep on hand. In Amboy, he met with Hampton, the twice-monthly regular for Perfectly Flawed’s services.
And at a train station parking lot in Princeton as temperatures crept above 80 degrees, he approached people experiencing housing insecurity and homelessness, and walked supplies over to them in the shade.
Rowlee said he has abused drugs in the past. A 42-year-old who spent years incarcerated, he wanted to “try something different” after being released, he said.
While the organization doesn’t approach people with the goal of getting them into recovery, they offer resources if those using their services decide to take that step themselves.
“There’s a lot of people that never got to the point where I got to, where I was like, ‘All right, I want to try something different.’ You know what I mean? … I just hope that it gives — everybody has the opportunity to make that choice for themselves, or not,” Rowlee said.
His rounds take him across LaSalle, Henry and Woodford counties and into all hours of the night, he said.
“I remember when I was on the other side of the van,” Rowlee said. “It’s — I don’t know if it’s any more welcoming or inviting, but it’s always — someone, if there’s someone on the other side, that has been there, had those experiences, can relate to a lot of things, people that we serve, there’s no shame.”
Individuals in contact with Perfectly Flawed self-reported more than 300 overdose reversals from January to July of this year, Tomsha said.
Princeton police Chief Tom Kammerer said he and his department are also practicing harm reduction strategies as part of a “multilayered approach” and rejected the idea that only certain groups would be equipped to do the work.
“There is enough work out there to go around, and there are plenty of people out there suffering who need help, and all these organizations need to work with one another to make sure that these people are getting the help that they need,” said Kammerer, who keeps tabs on people who are homeless in some of the same areas as Rowlee.
Harm reduction is not just about supplies or grant applications but about relationships, Tomsha and other advocates said.
Tomsha, who said he used heroin “chaotically” for 14 years, said at the time he was using he would have preferred to turn to someone like Rowlee than risk getting “stigmatized at the front desk of an ER or a clinician’s office.”
“People say, ‘You’re just giving out — you’re empowering people to use.’ Like, you’re actually empowering life and autonomy,” Tomsha said. “Stigma does kill.”
People have also developed close relationships through The Puerto Rico Project, which distributes food, supplies, showers and other services to people who are homeless in Chicago.
In Humboldt Park, project director Melissa Hernandez with the help of volunteers, staff and people who are homeless set up a table of harm reduction supplies — naloxone vials, boxes of syringes, snorting kits, cookers, condoms, xylazine test strips and other items — a few feet from a spread of hot dogs and drip coffee.
The project regularly brings a mobile shower unit with two stalls, fresh clothes and a small medicine cabinet with over-the-counter medications to the site near the corner of North and California avenues.
Angel Echevarria, Jose Echevarria and Tammy Huisel, who regularly use the showers, were among the first to arrive at the mobile site on a warm recent Monday.
But before they used any of the services, they helped Hernandez with setting things up.
They weren’t there for the harm reduction supplies, Jose Echevarria said, gathering with Huisel under Humboldt Park’s leafy late summer foliage next to a collection of tents for homeless people. But they helped out because of the sense of community and care that the site brought to them, they said.
‘This is a blessing’
“This is a blessing. God provided this for us. … You’ll scratch my back, I’ll scratch yours,” Angel Echevarria said.
Only access to smoking supplies is somewhat restricted, Hernandez said, because of the high cost for those kits. Other drug use supplies were out on a table for people to take as they pleased.
People who gathered from the nearby tent encampment at The Puerto Rico Project’s site in many cases hung around for longer than just their shower slot, making conversation in the grass and drinking coffee.
The whole setup is a form of harm reduction, Hernandez suggested, allowing people to gather in a community where they feel safe.
One of the people who took supplies for drug use, Joe Gonzalez, said he was staying in Humboldt Park, describing the neighborhood as his home.
“It’s beautiful that so many people even care, and care about everybody that’s out here, you know what I mean? And — the government, you know what I mean, and other people don’t get it. They won’t do it. But these people out here care,” he said.
Still, the government-distributed remediation fund could soon be funding some of the services at the site.
Additional funding could support salaries, supplies, food or a truck to tow the shower unit when the current lease runs out, Hernandez said. In its current setup, shower services will also be limited in the winter because of cold weather, she said.
The annual budget for Hernandez’s operation, which has four part-time employees, is $130,000, she said.
At Perfectly Flawed, Rowlee is one of five full-time employees, Tomsha said. The organization also has five part-time workers.
At that organization, a $300,000 grant from the opioid remediation fund is expected to fund an additional van and community outreach work; however, it’s not a harm reduction-specific grant and can’t be used for supplies like syringes, Tomsha said.
A larger grant could go to expanding mobile services, Tomsha said.
“We’re part of the public health,” Hernandez said. “People are actually wanting to take care of themselves … Even though we’re harm reduction, we’re always something else too.”
Which states have the worst substance abuse problems?
Which states have the worst substance abuse problems?
Accidental injuries, a category that includes drug overdoses, are the leading cause of death for Americans aged 18 to 45—a situation that seems unlikely to change any time soon.
A major contributing factor to this crisis is the opioid epidemic, which continues to ravage the country. More than 105,000 people died from a drug overdose in the 12-month period ending in November 2023, according to the latest data from the Centers for Disease Control and Prevention. This number is slightly lower than its peak in May of that same year but is twice the rate of 2015.
Counseling Schools looked at data from the CDC to see how the opioid epidemic is evolving across America. Since 2016, synthetic opioids like fentanyl have been the deadliest drug, accounting for over 80% of fatal overdoses.
Drug overdose deaths have been rising all across the country. As of 2023, coastal states and those in the Appalachian Mountains have been hit the hardest. Deadly drugs are especially prevalent in West Virginia, which suffered 78 deaths per 100,000 residents.
Ground Picture // Shutterstock
Drug deaths are rising
The modern opioid crisis started in the 1990s, when drug companies began marketing prescription opioids such as Purdue’s OxyContin (oxycodone) for pain management while understating their addictive qualities. In a settlement with state and local governments, the Sackler family, which owns Purdue, agreed to pay $6 billion while giving up control of the company. In turn, the Sackler family would be immune from opioid-related civil lawsuits. The Supreme Court has frozen the settlement to consider whether courts had the authority to grant such protections to the Sackler family.
The recent rise of fentanyl has made the oxycodone crisis seem tame. This synthetic opioid is estimated to be between 50 to 100 times more potent than morphine: Even a tiny dose can kill an adult, unlike oxycodone, and is primarily made illegally. One reason fentanyl has had such a wide reach in America is that it is often mixed in with other drugs, such as heroin, meth, or ecstasy. This allows drug makers to create more powerful narcotics at a lower cost but makes it easy for consumers to misjudge doses.
Counseling Schools
Fentanyl’s damage has been widespread
In 2015, Angus Deaton and Anne Case, two economists from Princeton University, popularized the phrase “deaths of despair” to describe America’s growing opioid problem. In a paper published in the Proceedings of the National Academy of Sciences, they observed that mortality rates for people ages 45 to 54 were on the rise in the United States, but declining in other high-income countries. The researchers also noted that deaths from drug overdoses were the highest for non-Hispanic white Americans. Using data that ran through 2013, the authors found the biggest contributors to the increase in these early deaths were poisoning (including overdoses), suicide, and chronic liver disease, the latter associated with excessive drinking. This research was widely quoted in the media, sparking numerous debates about why working-class white Americans were fairing so poorly.
Fentanyl’s widespread use has meant that opioid abuse can no longer be considered contained to one demographic group. A recent paper in JAMA Psychiatry by Joseph Friedman and Helena Hansen, medical researchers from the University of California, Los Angeles, points out that the death rate from drug overdoses and liver poisoning for Black Americans has now caught up to that of white Americans. The authors also note that Native Americans, who even before the rise of fentanyl had the highest alcohol-and-drug-related death rate, also experienced a massive increase in fatal overdoses.
Most illegal fentanyl is made in Mexico from chemicals in China and then smuggled into America, according to the Congressional Research Service. Stopping this trade has proven difficult, in part because of the drug’s potency—only a small amount is required per user. The Drug Enforcement Administration announced that it seized around 77 million fentanyl pills and about 12,000 pounds of fentanyl powder in 2023, the most of any year, indicating that demand for the drug is still sky-high.
Some policymakers are moving to target dealers and users of the drug. Oregon recently announced that it would recriminalize drugs, making “personal use possession” a misdemeanor. Residents of the state had previously voted to decriminalize most drug activity in 2020. The new law makes provisions for addiction and mental health services as an alternative to jail, implementing a middle ground.
Story editing by Shannon Luders-Manuel. Copy editing by Tim Bruns.
This story originally appeared on Counseling Schools and was produced and distributed in partnership with Stacker Studio.
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Which states have the worst substance abuse problems?
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Publish date : 2024-09-15 15:59:00
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