DkAI1 NC1 ICk CIkCULA1ICN - LM8AkGCLD ICk MLDIA kLLLASL on 8]11]1S DkAI1 NC1 ICk CIkCULA1ICN - LM8AkGCLD ICk MLDIA kLLLASL on 8]11]1S D|m|n|sh|ng Capac|ty:1he Peroln Crlsls and llllnols 1reaLmenL ln naLlonal erspecLlve llllnols ConsorLlum on urug ollcy aL 8oosevelL unlverslLy AugusL 2013 AuLhored by: kaLhleen kane-Wlllls Clovannl Avlles uavld 8arneLL !usLyna Czechowska ScoLL MeLzger 8oman 8lvera 8en[amln WalLe DkAI1 NC1 ICk CIkCULA1ICN - LM8AkGCLD ICk MLDIA kLLLASL on 8]11]1S DkAI1 NC1 ICk CIkCULA1ICN - LM8AkGCLD ICk MLDIA kLLLASL on 8]11]1S ACkNCWLLDGLMLN1S 1hls paper was funded ln parL by Lhe generous supporL of Lhe urug ollcy Alllance. MISSICN 1he ConsorLlum's prlmary ob[ecLlves are Lo promoLe dlscusslon of alLernaLlves Lo llllnols' currenL drug pollcles and Lo serve as a forum for Lhe open, honesL, and LhoughLful exchange of ldeas. We asplre Lo serve boLh Lhe general publlc and populaLlons slgnlflcanLly affecLed by drug pollcles Lhrough careful analysls of currenL pollcles ln Lhe areas of houslng, employmenL, educaLlon, soclal servlces, healLhcare and economlcs. We alm Lo offer senslble, prudenL, [usL and economlcally vlable alLernaLlves Lo lneffecLlve pollcles. 1he ConsorLlum seeks meanlngful change by lncreaslng dlalogue, helghLenlng publlc awareness, meeLlng wlLh leglslaLors, organlzlng lndlvlduals and communlLles, and expandlng ouLreach Lo oLher organlzaLlons LhaL are also lmpacLed by drug pollcles. 1he ConsorLlum vlews lndlvlduals and communlLles LhaL have been dlrecLly lmpacLed by drug pollcles as an lnLegral componenL for change. DkAI1 NC1 ICk CIkCULA1ICN - LM8AkGCLD ICk MLDIA kLLLASL on 8]11]1S DkAI1 NC1 ICk CIkCULA1ICN - LM8AkGCLD ICk MLDIA kLLLASL on 8]11]1S 1ab|e of Contents LxLCu1lvL SuMMA8? ................................................................................................................................. 1 naLlonal 1rends ........................................................................................................................................ 1 llllnols 1rends ........................................................................................................................................... 1 uecllnlng 1reaLmenL CapaclLy: llllnols ln naLlonal erspecLlve ................................................................ 2 ML1PCuCLCC? ........................................................................................................................................... 4 ln18CuuC1lCn ............................................................................................................................................ 3 PL8Cln uSL ln nA1lCnAL L8SLC1lvL ..................................................................................................... 6 lLLlnClS ?Cu1P PL8Cln uSL 8A1LS ............................................................................................................ 7 lLLlnClS S1A1L lunuLu 18LA1MLn1 LlSCuLS lC8 PL8Cln CCn1lnuL 1C 8lSL ..................................... 8 PL8Cln lnC8LASLS ln 8u8AL lLLlnClS Anu SMALLL8 ML18C A8LAS ........................................................ 9 CPlCACC ML18CCLl1An A8LA ln nA1lCnAL L8SLC1lvL .................................................................... 11 PL8Cln uSL AMCnC CCCk CCun1? A88LS1LLS: nA1lCnAL L8SLC1lvL ............................................. 12 LML8CLnC? uLA81MLn1 MLn1lCnS lC8 PL8Cln ln 1PL CPlCACC ML18CCLl1An A8LA: nA1lCnAL L8SLC1lvL .............................................................................................................................................. 13 uLCLlnlnC 18LA1MLn1 CAACl1?: lLLlnClS ln nA1lCnAL L8SLC1lvL ................................................. 14 1PL lMAC1 Cl ulMlnlSPLu CAACl1?, uLCLlnlnC S1A1L lunulnC Anu MLulCAlu ............................ 18 rovldlng 1reaLmenL Saves Money and lncreases ubllcly SafeLy ......................................................... 18 AddlLlonal 8eneflLs of MA1 - Plv and PCv 8educLlons ......................................................................... 18 CLlC? 8LCCMMLnuA1lCnS ..................................................................................................................... 20 Address Lhe sLrongesL rlsk facLor for heroln addlcLlon: AddlcLlon Lo prescrlpLlon oplold palnklllers. ... 20 lncrease access Lo and Lralnlng for admlnlsLerlng naloxone Lo reduce heroln and oLher oplold overdose deaLhs. .................................................................................................................................... 20 Lnsure LhaL all medlcaLlon asslsLed LreaLmenL (MA1) ls covered by Medlcald, wlLhouL Llme llmlLs. .... 21 Lnsure LhaL sLaLe funded drug courLs are followlng evldence based pracLlces as ls requlred wlLh federally funded drug courLs, especlally Lhe lncluslon of MA1. ............................................................. 21 Lxpand access Lo MA1 ln counLy [alls and sLaLe prlsons and sLrengLhen llnkages beLween correcLlonal faclllLles and MA1 provlders. ................................................................................................................. 21 lncrease Lhe avallablllLy of syrlnges and knowledge of syrlnge access laws and harm reducLlon pracLlces ln llllnols. ................................................................................................................................. 22 lncrease sLaLe funded LreaLmenL capaclLy for lndlvlduals wlLh heroln or oplaLe use dlsorders. ........... 22 lmprove daLa collecLlon around heroln and oplold lndlcaLors. ............................................................. 22 ALnulx A (1reaLmenL Lplsode uaLa SeL (1LuS) Analysls) ...................................................................... 23 ALnulx 8 (ArresLee urug Abuse MonlLorlng rogram (AuAM) Analysls) .............................................. 29 ALnulx C (urug Abuse Warnlng neLwork (uAWn) Analysls) ................................................................. 31 1 LkLCU1IVL SUMMAkNat|ona| 1rends 1hls rlse of heroln use has been a ma[or focus of concern among governmenL agencles such as Lhe CenLers for ulsease ConLrol (CuC), Lhe SubsLance Abuse MenLal PealLh Servlces AdmlnlsLraLlon (SAMPSA), and Lhe Cfflce of naLlonal urug ConLrol ollcy (CnuC) and daLa verlfy Lhese concerns: ln 2013, Lhe number of lndlvlduals (681,000) reporLlng pasL year heroln use was slgnlflcanLly hlgher Lhan ln 2007 (314,000), nearly doubllng over Lhe slx year perlod. ln 2012, Lhose enLerlng LreaLmenL reporLlng heroln as Lhls prlmary subsLance of abuse lncreased Lo 16 of all LreaLmenL admlsslons, Lhe hlghesL level slnce daLa collecLlon began ln 1992. Peroln overdoses (polsonlngs) have nearly quadrupled from 2002 Lo 2013, wlLh 8,200 deaLhs ln 2013. I|||no|s 1rends Whlle heroln LreaLmenL eplsodes are reachlng hlsLorlc hlghs naLlonally, ln llllnols LreaLmenL admlsslons for heroln are slgnlflcanLly hlgher Lhan Lhe naLlon as a whole, for example: naLlonally, heroln LreaLmenL admlsslons comprlsed 16.4 of LoLal sLaLe funded LreaLmenL ln 2012, whlle ln llllnols heroln admlsslons make up one-quarLer of all LreaLmenL admlsslons for Lhe sLaLe, and are 36 greaLer Lhan Lhe naLlon as a whole, ln 2012, Lhe Chlcago MeLropollLan Area percenLage of LreaLmenL admlsslons for heroln was more Lhan double Lhe naLlonal average (33.1 vs 16.4).lrom 2006 Lo 2012, heroln was Lhe second mosL common reason for llllnolsans Lo enLer sLaLe publlcly funded LreaLmenL, afLer alcohol. ln 2000, lL was Lhe 4Lh mosL common reason. Peroln use ls noL only rlslng ln urban areas area buL ls also dramaLlcally lncreaslng ln rural and suburban counLles.ln 2007, LreaLmenL eplsodes for heroln comprlsed [usL 4 of LoLal publlcly funded LreaLmenL ln MeLro LasL llllnols, buL by 2012, heroln made up 18 of all LreaLmenL eplsodes - a fourfold lncrease ln [usL 3 years. ln 2007, LreaLmenL admlsslons ln uecaLur for heroln comprlsed [usL 3 of Lhe LoLal, splklng Lo 23 ln 2012, represenLlng a 6-fold lncrease. ln 2007, LreaLmenL admlsslons ln eorla-ekln for heroln were 7 and by 2012 lL was 16, a 119 lncrease.8eLween 2007 and 2012, LreaLmenL eplsodes for heroln more Lhan doubled ln 8loomlngLon-normal and Champalgn- urbana from 3 Lo 11 and 6 Lo 13 respecLlvely. Accordlng Lo survey daLa heroln use ls lncreaslng especlally among young people ln llllnols. ln 2007, 2.3 of llllnols youLh reporLed uslng heroln ln Lhe pasL year, whlle ln 2013, LhaL number lncreased Lo 3.8, a nearly 30 percenL lncrease ln [usL slx years. 2 1he greaLesL percenLage lncrease occurred among females - a 90 lncrease over LhaL Llme perlod.Males were more llkely Lo reporL uslng heroln - nearly slx percenL ln 2013. 1he Chlcago MeLropollLan Area ranks ln Lhe Lop for boLh emergency deparLmenL menLlons for heroln and number of lndlvlduals who were arresLed and LesLed poslLlve for heroln. ArresLees from Cook CounLy LesLed poslLlve for oplaLes (lncludlng heroln) aL a raLe of 18.6, hlgher Lhan any oLher area ln Lhe naLlon. ArresLees from Cook CounLy also self-reporLed uslng heroln more Llmes per monLh Lhan Lhose from any oLher [urlsdlcLlon, (26.8 days per monLh). ArresLees from Cook CounLy reporLed uslng heroln ln Lhe lasL Lhree days more Lhan Lhose from any oLher reglon (13.7). 1he Chlcago MeLropollLan area ranked flrsL ln Lhe counLry for Lhe LoLal number of menLlons for heroln (23,627) nearly double Lhe number for new ?ork ClLy.Chlcago also reporLed Lhe hlghesL number of heroln menLlons among Afrlcan Amerlcan menLlons (13,178), nearly four Llmes more Lhan new ?ork ClLy (3,463) and nearly 6 Llmes hlgher Lhan ueLrolL (2,311). Among whlLes, only 8osLon had more Lu menLlons for heroln (10,043), buL Chlcago was second (7,024). Chlcago ranked hlghesL ln Lhe number of Lu menLlons for boLh women and men. Ad[usLlng for populaLlon, Chlcago ranked 2nd hlghesL ln Lhe number of menLlons overall, behlnd 8osLon. Dec||n|ng 1reatment Capac|ty: I|||no|s |n Nat|ona| erspect|ve Whlle heroln use ls lncreaslng ln every area of Lhe sLaLe, Lhere has been an alarmlng and dramaLlc decrease ln LreaLmenL from 2007 Lo 2012. llllnolsranked!"#$%lnLheuSforLhedecllnelnLreaLmenLcapaclLyoverLhlsperlod,alossof more Lhan half of lLs LreaLmenL eplsodes, 32 decrease over Lhe flve year perlod. ln2007,llllnolsranked28LhlnsLaLefundedLreaLmenLcapaclLy,buLln2012llllnolsranked44Lh, or 3rd worsL ln Lhe naLlon, only 1ennessee and 1exas ranked lower. ln 2012, llllnols's sLaLe funded LreaLmenL raLe was (263 per 100k) more Lhan 30 lower Lhan Lhe uS raLe. When compared Lo oLher MldwesLern sLaLes, llllnols had Lhe lowesL raLe of sLaLe funded LreaLmenL. MlnnesoLa's raLe was 2.7 Llmes llllnols's raLe (982.1 vs 236.6), Chlo's raLe was Lwlce as hlgh as llllnols, Wlsconsln raLe was 1.8 Llmes greaLer, and lndlana's raLe, whlch was lower Lhan LhaL for any MldwesLern sLaLe, aslde from llllnols, was $%"'' 43 hlgher Lhan llllnols. llllnols SLaLe fundlng for addlcLlon LreaLmenL decreased slgnlflcanLly: lrom 2007 Lo 2012, Ceneral 8evenue lundlng decreased by nearly 30 ($111M vs $79M), whlle Medlcald fundlng decreased by 4 over Lhls Llme perlod. 3 1hese decreases ln fundlng conLlnue ln l? 16, where Lhe proposed budgeL represenLs a 61 decrease ln sLaLe funded addlcLlon LreaLmenL, lncludlng Medlcald lncreases from l?13 Lo l?16, addlcLlon LreaLmenL fundlng (lncludlng Medlcald), sLlll dropped by 28 overall ($163M ln 2007 Lo $116M ln Lhe proposed l?16 budgeL) Accord|ng to the CDC States can: 1.Lxpand LreaLmenL for Lhose wlLh heroln and oplaLe use dlsorder, especlally MedlcaLlon AsslsLed 1reaLmenL (MA1, lncludlng meLhadone and buprenorphlne), whlch would lower crlme and save Laxpayer money: Lach dollar spenL on meLhadone malnLenance ylelds a cosL savlng ln Lerms of crlme reducLlon beLween $4 and $7. When healLh care cosLs are lncluded, Lhe beneflLs reLurned are $12 for each $1 lnvesLed, Lnsure LhaL all medlcaLlon asslsLed LreaLmenL ls covered by Medlcald, wlLhouL Llme llmlLs. 1he beneflLs of provldlng meLhadone for [usL 2,300 people could save Lhe SLaLe abouL $82.3-$100M ln reduced crlme and healLh care consequences (lncludlng Lhe cosL of Lhe LreaLmenL). Lxpanslon of MA1 could reduce Lhe prlson populaLlon among class 4 offenders alone by approxlmaLely 1,000 cases per year. 2.lncrease access Lo and Lralnlng for admlnlsLerlng naloxone Lo reduce heroln and oLher oplold overdose deaLhs. 1he SLaLe of llllnols should lnvesL fundlng ln exlsLlng naloxone programs slnce naloxone klLs are slgnlflcanLly cheaper Lhan an overdose deaLh abouL $23-$40 and $30,000, respecLlvely. 3.Lnsure LhaL sLaLe funded drug courLs are followlng evldence based pracLlces as ls requlred wlLh federally funded drug courLs, especlally Lhe lncluslon of MA1. 4.lncrease avallablllLy of syrlnges and knowledge of syrlnge access laws and harm reducLlon pracLlces ln llllnols. 3.Address Lhe sLrongesL rlsk facLor for heroln addlcLlon: addlcLlon Lo prescrlpLlon oplold palnklllers.0.0 100.0 200.0 300.0 400.0 300.0 600.0 700.0 800.0 2000200120022003200420032006200720082009201020112012 1ota| I|||no|s 1reatment Lp|sodes per 100,000(2000 - 2012) 4 ML1nCDCLCG 1hls brlef reporL ls an updaLe Lo ()#*"+ ,$)- ./%"*+/' /+0 1''"+*"$ 2)#$3)4%"5)$6 7889 %* 78:81. 1hls updaLe examlnes publlc LreaLmenL daLa, emergency deparLmenL sLaLlsLlcs, and arresL daLa uslng Lhe mosL recenL and compleLe years avallable. uaLa was gaLhered from Lhe naLlonal Pousehold Survey on urug use and PealLh, Lhe 1reaLmenL Lplsode uaLa SeL, Lhe urug Abuse Warnlng neLwork, Lhe ?ouLh 8lsk 8ehavlor Survelllance SysLem, and Lhe ArresLee urug Abuse MonlLorlng program. 1he followlng meLhodologlcal noLes regardlng Lhe daLa seLs wlll provlde addlLlonal lnformaLlon on Lhe daLa conLalned wlLhln Lhls reporL. Nat|ona| nouseho|d Survey on Drug Use and nea|th (NSDUn) - 1he 2013 daLa seL was used for Lhls reporL Lo provlde lnformaLlon on heroln lnlLlaLes and use paLLerns ln Lhe unlLed SLaLes. uownloaded !uly, 2013.1reatment Lp|sode Data Set (1LDS) - 1he 2007 and 2012 daLa seLs were used for Lhls reporL Lo provlde lnformaLlon on use of publlc LreaLmenL servlces for heroln problems ln Lhe unlLed SLaLes and llllnols. lL ls lmporLanL Lo noLe LhaL one person can undergo mulLlple LreaLmenL eplsodes. uaLa were noL reporLed for Alabama (2007), Mlsslsslppl (2012), ennsylvanla (2012), and WesL vlrglnla (2012). uownloaded !uly, 2014. Drug Abuse Warn|ng Network (DAWN) - 1he 2011 daLa seL was used for Lhls reporL Lo provlde deLalls on Lhe number and raLes of lndlvlduals recelvlng emergency medlcal servlces for heroln problems LhroughouL Lhe unlLed SLaLes and Lhe Chlcago MeLropollLan Area. 1he research Leam also analyzed Lhls daLa by race, comparlng whlLe and Afrlcan Amerlcan lndlvlduals who recelved emergency medlcal servlces due Lo heroln use. uaLa for Mlaml and Mlaml - lL. Lauderdale ulvlslon were omlLLed due Lo lack of daLa and dlsproporLlonaLely small sample slze, respecLlvely. uAWn ls currenLly belng resLrucLured, up Lo daLe daLa wlll noL be released unLll 2017. 1he 2011 daLa was downloaded !uly, 2013. outh k|sk 8ehav|or Surve|||ance System (k8SS) - 1he research Leam conducLed onllne analysls of Lhe 2007 and 2013 daLa, whlch were compared Lo provlde lnformaLlon on Lhe use of heroln among male and female youLh. Accessed !uly, 2013. Arrestee Drug Abuse Mon|tor|ng rogram (ADAM) - 1he 2011 daLa seL was used for Lhls reporL Lo provlde lnformaLlon on Lhe use of heroln and oLher oplaLes among adulL male arresLees ln ma[or unlLed SLaLes clLles. 1he 2011 daLa seL was chosen over Lhe more recenL 2012 daLa seL because Lhe laLLer omlLLed a number of clLles and was Lherefore less meanlngful Lhan 2011 ln our analysls. uownloaded !uly, 2013.

3 IN1kCDUC1ICN 1he llllnols ConsorLlum on urug ollcy has Lrended Lhe rlse ln heroln use slnce 2004. 1he lasL Llme Lhe ConsorLlum analyzed daLa relaLed Lo heroln use ln llllnols was ln 2012, uslng daLa from 2010.lnlLlally, our research Leam began Lo look aL publlc LreaLmenL overall and found LhaL Lhe number of crlmlnal [usLlce referred LreaLmenLs for marl[uana represenLed a slgnlflcanL porLlon of LreaLmenL admlsslons boLh ln llllnols and across Lhe naLlon. Slnce Lhe heroln and oplold crlsls had been lncreaslng ln severlLy, we consldered Lhe lmpacL of Lhese admlsslons for marl[uana, as publlcly funded LreaLmenL ls by lLs naLure llmlLed.1he naLure of oplold and heroln addlcLlon ls assoclaLed wlLh many negaLlve socleLal lmpacLs lncludlng crlmes of acqulslLlon (e.g. LhefL), whlle wlLh marl[uana, use does noL have Lhe same effecLs on publlc safeLy.2 Peroln and oplold can lead Lo overdose and deaLh, and Lhe rlsk of blood borne paLhogen Lransmlsslon (Plv and PepaLlLls C) LhaL have dlre lmpacLs on boLh Lhose wlLh addlcLlons, Lhelr famlly members and socleLy as a whole. AL LhaL Llme, we noLlced an odd decrease when analyzlng Lhe demographlc changes.1hese pecullarlLles ln Lhe daLa, whlch had been Lrended slnce 1996, requlred furLher analysls. 1he researchers concluded lL mlghL have been a reporLlng error ln Lhe 2011 daLa, buL Lhls paLLern perslsLed over Llme, lnLo 2012.8ecause of Lhese changes ln LreaLmenL eplsodes, we declded Lo look and compare llllnols Lo oLher sLaLes ln Lerms of publlcly funded LreaLmenL eplsodes and compare Lhem Lo Lhe resL of Lhe naLlon.1hls comparlson seemed Llmely as lL has been well esLabllshed by governmenL agencles and oLhers LhaL Lhe heroln and oplold crlsls ln llllnols were sLlll growlng across Lhe naLlon. 6 nLkCIN USL IN NA1ICNAL LkSLC1IVL 1hls rlse of heroln use has been feaLured exLenslvely ln news reporLs, communlLy forums, among law enforcemenL, publlc healLh offlclals, and governmenL agencles, especlally over Lhe pasL 3 years. Accordlng Lo boLh Lhe ConsorLlum's research and Lhe CenLers for ulsease ConLrol (CuC), across Lhe naLlon, heroln use has lncreased among mosL demographlc groups, genders, ages and lncome levels.WhaL has garnered perhaps Lhe mosL aLLenLlon, parLlcularly ln Lhe medla, ls Lhe lncrease among groups noL hlsLorlcally assoclaLed wlLh heroln use, lncludlng women, lndlvlduals wlLh lnsurance and Lhose from hlgher SLS households.3 Among Lhose aged 18-24, heroln use doubled over Lhe lasL Len years4.Survey daLa demonsLraLe LhaL Lhe number of people who use heroln ln Lhe unlLed SLaLes has conLlnued Lo rlse slnce 2002. ln 2013, Lhe number of lndlvlduals (681,000) reporLlng pasL year heroln use was slgnlflcanLly hlgher Lhan ln 2007 (314,000), nearly doubllng over LhaL slx year perlod.Whlle flrsL Llme use of heroln remalned sLable over Lhls Llme perlod, wlLh 169,000 new lnlLlaLes ln 2013. 1he age of flrsL use or lnlLlaLlon lncreased sllghLly from 23 years ln 2012 Lo 24.3 years ln 2013.3 1he rlse ln heroln use has also been accompanled by a rlse ln heroln morLallLy: heroln-relaLed overdoses (polsonlngs) have nearly quadrupled from 2002 Lo 2013, wlLh 8,200 lndlvlduals dead ln 2013.6 Many of Lhese polsonlngs lnvolvlng heroln and oLher oplolds are caused by Lhe use of Lhese drugs ln comblnaLlon wlLh oLher drugs, llke alcohol, benzodlazeplnes, and cocalne.7 Powever, heroln-relaLed deaLhs are llkely undercounLed.Peroln ls meLabollzed ln Lhe body as morphlne, and Loxlcology screens ofLen deLecL Lhe presence of morphlne meLabollLes ln Llssue samples. 8Powever, Lhere ls only a small wlndow of opporLunlLy ln whlch heroln can be ldenLlfled as conLrlbuLlng Lo deaLh Lhrough Lhe morphlne marker ;'=*#3?"+)@9 Many medlcal examlners lack Lhe resources Lo perform Lhese very speclflc LesLs, opLlng lnsLead Lo screen for morphlne and code Lhe deaLh as an oplaLe deaLh.Peroln overdoses need noL be faLal.Peroln and oLher oplaLe polsonlngs can be reversed wlLh naloxone (narcan) and Lhere have been advances ln geLLlng Lhe overdose reversal drugs more avallable Lo law enforcemenL and Lhe general publlc, so LhaL no one need dle from an overdose, lf lndlvlduals are Lralned ln overdose prevenLlon and naloxone ls avallable.10 7 ILLINCIS CU1n nLkCIN USL kA1LS Peroln use ls also lncreaslng among young people ln llllnols accordlng Lo survey daLa. 1he ?ouLh 8lsk Survelllance SysLem, a survey of llllnols youLh, showed an lncrease ln hlgh school youLh reporLlng heroln use.ln 2007, 2.3 of llllnols youLh reporLed uslng heroln ln Lhe pasL year, whlle ln 2013, LhaL number lncreased Lo 3.9, a more Lhan 30 percenL lncrease ln [usL slx years.1he greaLesL percenLage lncrease occurred among females - a 90 lncrease over LhaL Llme perlod.11 Males were more llkely Lo reporL uslng heroln - nearly slx percenL ln 2013l 12 (1able 2). 1ab|e 2: I|||no|s outh keport|ng nero|n Use |n 2007 and 2013 ast ear Use20072013Abso|ute Change Change 1oLal2.33.91.436 lemale1.01.90.990 Male4.03.61.640 i YBRSS analyses are conducted every two years; therefore 2013 was utilized for this analysis. 8 ILLINCIS S1A1L IUNDLD 1kLA1MLN1 LISCDLS ICk nLkCIN CCN1INUL 1C kISL Along wlLh Lhe rlse ln youLh use, and oLher lndlcaLors, analyses of Lhe 1reaLmenL Lplsode uaLa SeL (1LuS) demonsLraLe Lhe rlse of lndlvlduals enLerlng publlcly funded LreaLmenL for heroln across llllnols.ln 2000, Lhe mosL common reason Lo enLer publlcly funded LreaLmenL was alcohol, followed by cocalne, marl[uana, and heroln. lrom 2003 Lo 2006, LreaLmenL admlsslons for heroln lncreased by nearly 34 (from 12,387 Lo 19,632).lrom 2006 Lo 2012 heroln was Lhe second mosL common reason llllnolsans enLered publlcly funded LreaLmenL, behlnd alcohol (llgure 1).13 I|gure 1: State Iunded 1reatment Adm|ss|ons by Substance and ercent of 1ota| (2000-2012) 0 10 20 30 40 30 60 70 80 90 100 2000200120022003200420032006200720082009201020112012 ercent of 1ota| 1reatment Lp|sodes by Substance (2000 - 2012) All CLher MeLh Peroln Marl[uana Cocalne Alcohol 9 nLkCIN INCkLASLS IN kUkAL ILLINCIS AND SMALLLk ML1kC AkLAS Cne mlghL Lhlnk LhaL heroln use ls conflned malnly Lo Lhe Chlcago MeLropollLan Area, lncludlng Lhe suburbs and collar counLles buL LhaL ls noL Lhe case, parLlcularly ln recenL years. nearly all of Lhe smaller MeLro Areas and even rural areas have seen Lhe proporLlon of LreaLmenL eplsodes for heroln lncrease. lor example, ln 2007, LreaLmenL eplsodes for heroln comprlsed [usL 4 of LoLal publlcly funded LreaLmenL ln MeLro LasL llllnols, buL by 2012, heroln made up 18 of all LreaLmenL eplsodes - a fourfold lncrease ln [usL 3 years.uecaLur demonsLraLed a slmllar rlse ln 2007, LreaLmenL admlsslons for heroln comprlsed [usL 3 of Lhe LoLal, splklng Lo 23 ln 2012, represenLlng a 6-fold lncrease.8ural llllnols has been slmllarly lmpacLed (llgures 2-3).14 I|gure 2: ercent of State Iunded 1reatment Adm|ss|ons for nero|n |n Se|ected I|||no|s Metro and kura| Areas (2007 to 2012) S 11 6 13 3 23 7 16 24 24 4 18 8 12 3 7 0 3 10 13 20 23 30 2007201220072012200720122007201220072012200720122007201220072012 8|oom|ngton-Norma| Champa|gn-Urbana Decatur Metro eor|a-ek|nkockford Metro Metro LastSpr|nghe|d Metro kura| ercent of 1ota| State Iunded 1reatment for nero|n(2007 to 2012) 10 I|gure 3: ercent Change |n roport|on of State Iunded 1reatment Adm|ss|ons for nero|n |n Se|ected I|||no|s Metro and kura| Areas (2007 - 2012) 11 CnICAGC ML1kCCLI1AN AkLA IN NA1ICNAL LkSLC1IVL 1he Chlcago MeLropollLan Area has long been aware of Lhe rlse of heroln use.ln numerous reporLs, Lhe ConsorLlum has ldenLlfled Chlcagoland as ranklng among Lhe worsL ln Lhe naLlon among oLher clLles for heroln use lndlcaLors.Accordlng Lo epldemlologlsLs, heroln overdose deaLhs ln Lhe collar counLles represenL Lhe mosL lmporLanL drug relaLed lssue ln 2011 and 2012.AddlLlonally, heroln lndlcaLors have lncreased or remalned aL exLremely hlgh elevaLed levels slnce 2000.13 1he percenLage of publlcly funded LreaLmenL admlsslons for heroln ln Lhe Chlcago MeLro Area lncreased sllghLly from 2007 Lo 2012.ln 2007, LreaLmenL admlsslons for heroln comprlsed 33.9 of Lhe LoLal, ln 2012, Lhese rose by 1.3 Lo 33.1 (1able 3). ln 2012, LreaLmenL admlsslons for heroln naLlonally comprlsed 16.4 of Lhe LoLal admlsslons. 1he Chlcago MeLropollLan Area's percenLage of LreaLmenL admlsslons was more Lhan 0*AB') Lhe naLlonal average.16 1ab|e 3: State Iunded 1reatment Adm|ss|ons for nero|n |n |n the Ch|cago Metro Area and US by ercent of 1ota| 2007 to 2012 earI|||no|s 1ota|US 1ota| 200733.913.3 201233.116.4

12 nLkCIN USL AMCNG CCCk CCUN1 AkkLS1LLS: NA1ICNAL LkSLC1IVL Chlcagoland (Cook CounLy) ranked flrsL ln Lhe naLlon for heroln use among arresLees ln 2011, accordlng Lo mulLlple lndlcaLors. Accordlng Lo Lhe ArresLee urug use MonlLorlng rogram (AuAM), arresLees from Chlcago LesLed poslLlve for oplaLes (lncludlng heroln) aL a raLe of 18.6, hlgher Lhan any oLher clLy ln Lhe naLlon whlle orLland ranked 2nd ,WashlngLon uC 3rd, and new ?ork ClLy 7Lh(1able 4). ArresLees from Cook CounLy also self-reporLed uslng heroln more Llmes per monLh Lhan Lhose from any oLher area, (26.8 days per monLh) whlle Mlnneapolls ranked 4Lh, and lndlanapolls ranked lasL (13.2 days per monLh) (Appendlx 8, 1able 8.2) ln Lhls respecL. llnally, arresLees from Chlcagoland reporLed uslng heroln ln Lhe lasL Lhree days more Lhan Lhose from any oLher clLy (13.7), whlle lndlanapolls ranked 6Lh and lndlanapolls ranked 8Lh.ComparaLlvely, new ?ork ClLy ranked 7Lh ln Lhls analysls-3.1 of arresLees reporLed uslng heroln ln Lhe lasL Lhree days (Appendlx 8, 1able 8.3).17 1ab|e 4: ercent of Adu|t Ma|e Arrestees 1est|ng os|t|ve for Cp|ates (|nc|ud|ng hero|n) |n Ur|ne 1ests by C|ty, 2011 (ADAM) kankC|tyercent 1Chlcago18.6 2orLland14.4 3WashlngLon uC11.3 4lndlanapolls10.3 3uenver10.1 6SacramenLo9.6 7 new ?ork8.1 8Mlnneapolls7.7 9ALlanLa6.6 10CharloLLe1.8 13 LMLkGLNC DLAk1MLN1 MLN1ICNS ICk nLkCIN IN 1nL CnICAGC ML1kCCLI1AN AkLA: NA1ICNAL LkSLC1IVL Accordlng Lo Lhe urug Abuse Warnlng neLwork, Lhe Chlcago MeLropollLan Area ranked flrsL or second ln a number of key lndlcaLors for heroln among lndlvlduals uslng Lhe emergency room (emergency deparLmenL or Lu) ln Lhe naLlon.Chlcago ranked flrsL ln Lhe counLry for Lhe LoLal number of menLlons for heroln (23,627), nearly double Lhe number for new ?ork ClLy (12,013) (1able 3).Chlcago also reporLed Lhe hlghesL number of heroln menLlons among Afrlcan Amerlcan menLlons (13,178), nearly four Llmes more Lhan new ?ork ClLy (3,463) and nearly 6 Llmes hlgher Lhan ueLrolL (2,311) (Appendlx C, 1able C.3). Among whlLes, only 8osLon had more Lu menLlons for heroln (10,043) Lhan Chlcago (7,024) (Appendlx C, 1able C.4). Chlcago ranked hlghesL ln Lhe number of Lu menLlons for boLh women and men (Appendlx C, 1ables C.3 and C.7).Ad[usLlng for populaLlon, Chlcago ranked 2nd hlghesL ln Lhe number of menLlons overall, behlnd 8osLon (Appendlx C, 1ables C.6 and C.8).18

1ab|e S:1ota| Lmergency Department Ment|ons19 for nero|n, by C|ty 2011 kankMetro AreaMent|ons 1Chlcago24,627 28osLon14,037 3new ?ork 12,013 4ueLrolL6,643 3SeaLLle6,208 6hoenlx4,092 8Mlnneapolls3,493 7uenver1,894 9San lranclsco731 14 DLCLINING 1kLA1MLN1 CAACI1: ILLINCIS IN NA1ICNAL LkSLC1IVL Whlle heroln use ls lncreaslng ln every area of Lhe sLaLe, Lhere has been an alarmlng and dramaLlc decrease ln LreaLmenL from 2007 Lo 2012.llllnols ranked flrsL ln Lhe uS for Lhe percenL decllne ln LreaLmenL capaclLy over Lhls perlod, a loss of more Lhan half of lLs LreaLmenL eplsodes- a 32 decrease (1able 6) ln [usL 3 years. ln 2007, llllnols ranked 28Lh ln sLaLe funded LreaLmenL capaclLy.ln 2012, llllnols fell Lo 44 ouL of 46 sLaLes avallable for analyslsll ranklng above only 1ennessee and 1exas (1ables, 7-8).20 llllnols's publlcly funded LreaLmenL raLe, ad[usLed for populaLlon, was well below Lhe naLlonal average. ln 2012, Lhe average naLlonal publlcly funded LreaLmenL raLe was 393 per 100,000.llllnols's raLe was [usL 263 per 100,000, less Lhan half of Lhe uS raLe.21

As compared Lo oLher nelghborlng or MldwesLern sLaLes, llllnols had Lhe lowesL raLe of sLaLe funded LreaLmenL. SouLh uakoLa's LreaLmenL raLe, ranked flrsL ln Lhe naLlon, was more Lhan 6.3 Llmes greaLer Lhan llllnols's (1741.9 vs. 263.6), MlnnesoLa's raLe was 2.7 Llmes llllnols's raLe (982.1 vs 263.6), Chlo's raLe was Lwlce as hlgh as llllnols's, and Wlsconsln's raLe was 1.8 Llmes greaLer. lndlana's raLe, whlch was lower Lhan LhaL of any MldwesLern sLaLe, aslde from llllnols, was $%"'' 43 hlgher Lhan llllnols (1able 9).llgure 4 shows Lhe decllne ln llllnols LreaLmenL eplsodes from 2000-2012.22 llllnols SLaLe fundlng for addlcLlon LreaLmenL decreased slgnlflcanLly. lrom 2007 Lo 2012 Ceneral 8evenue lundlng decreased by nearly 30 ($111M vs $79M), whlle Medlcald fundlng decreased by 4 over Lhls Llme perlod.231hese decreases ln fundlng conLlnue ln l? 16, where Lhe proposed budgeL represenLs a 61 decrease ln sLaLe funded addlcLlon LreaLmenL (noL lncludlng Medlcald).24lncludlng Lhe lncreases ln Medlcald from l?13 Lo l?16, addlcLlon LreaLmenL fundlng (lncludlng Medlcald), sLlll dropped by 28 overall ($163M ln 2007 Lo $116M ln Lhe proposed l?16 budgeL (llgure 3)).23 ii Several states did not report either in 2007 or 2012, and were not included in these tables. These states include Alabama, Pennsylvania, Mississippi and West Virginia. 13 1ab|e 6:State Iunded 1reatment Adm|ss|ons w|th the kanked by Largest ercent Decrease (1op 10)(2007-2012) kankStateChange 1I|||no|s-S2 2new Mexlco-48 3Loulslana-44 4Chlo-42 3kenLucky-33 6SouLh Carollna-29 7Arkansas-23 8Cklahoma-23 9new Pampshlre-23 10Callfornla-24 uS 1oLal-11 1ab|e 7:n|ghest State Iunded 1reatment Adm|ss|ons by kate, |nc|ud|ng I|||no|s and US (2007) kankStatekate per 100k 1SouLh uakoLa1,981.1 2Colorado1,633.1 3new ?ork1,399.2 4MassachuseLLs1,417.1 SCregon1,406.4 6vermonL1,309.9 7ConnecLlcuL1,277.9 8Malne1,213.6 9Maryland1,200.0 108hode lsland1,074.7 28I|||no|sSS2.9 NAuS 1C1AL668.6 16 1ab|e 8: n|ghest State Iunded 1reatment Adm|ss|ons by kate, |nc|ud|ng I|||no|s and US (2012) kankStatekate 1SouLh uakoLa1,741.9 2ConnecLlcuL1,726.6 3Colorado1,688.6 4new ?ork1,303.6 3vermonL1,402.9 6MassachuseLLs1,320.3 7Cregon1,132.7 8Maryland1,101.4 9Malne1,037.2 108hode lsland1,026.4 44I|||no|s26S.6 431ennessee209.3 461exas161.6 uS 1oLal393.3 1ab|e 9: M|dwestern State Iunded 1reatment Adm|ss|ons by kate per 100k (2012) kankStatekate 1SouLh uakoLa1,741.911MlnnesoLa982.112nebraska949.113lowa907.919Mlssourl749.020Mlchlgan333.022Chlo313.724Wlsconsln493.727kansas437.433lndlana382.844I|||no|s26S.6 17 I|gure 4: State Iunded 1reatment Adm|ss|ons kate (2000-2012) I|gure S: I|||no|s 1reatment Iund|ng by 1ype (2007- 2016) 0.0 100.0 200.0 300.0 400.0 300.0 600.0 700.0 800.0 2000200120022003200420032006200720082009201020112012 1ota| I|||no|s 1reatment Lp|sodes per 100,000(2000 - 2012) 5111,12S,000!"#$%&'$('' 5S2,234,900!*"$+(,$%'' $- $20,000,000 $40,000,000 $60,000,000 $80,000,000 $100,000,000 $120,000,000l? 07l? 08l? 09l? 10l? 11 l?12 l?13l?14l?13roposed l?16 Add|cnon 1reatment and kecovery Support Ceneral 8evenue lundlngMedlcald lundlng 18 1nL IMAC1 CI DIMINISnLD CAACI1, DLCLINING S1A1L IUNDING AND MLDICAID Accordlng Lhe CenLers for ulsease ConLrol, expandlng access Lo LreaLmenL, especlally medlcaLlon asslsLed LreaLmenL (MA1), llke meLhadone and buprenorphlne, ls essenLlal Lo reduclng Lhe heroln epldemlc.26 ln llllnols, meLhadone ls currenLly noL covered under Medlcald for addlcLlon LreaLmenL and Medlcald coverage for buprenorphlne LreaLmenL ls llmlLed Lo [usL one year.27 CurrenLly, Lhe only way for llllnolsans Lo recelve MA1 coverage ls Lhrough sLaLe funded programs, whlch have been cuL by more Lhan 30 percenL, or Lo pay ouL of pockeL. 1hls creaLes a scenarlo whlch makes Lhe heroln crlsls slgnlflcanLly worse. rov|d|ng 1reatment Saves Money and Increases ub||c|y Safety 8esearch demonsLraLes LhaL LreaLmenL- overall - for subsLance use dlsorder ls cosL effecLlve and saves money. lor every $1 spenL on LreaLmenL, socleLy as a whole saves $7. Some of Lhese Laxpayer savlngs come from crlme reducLlon beneflLs, lncludlng reducLlons ln:1) [all and prlson Llme, 2) law enforcemenL cosLs, 3) crlme vlcLlms, and 4) courL cosLs. eople ln LreaLmenL also spend less Llme ln hosplLals, emergency rooms, and menLal healLh servlces, savlng Laxpayers even more. ln Lhls way LreaLmenL noL only lmproves Lhe healLh and quallLy of llfe of Lhose who use lL, buL lL also saves money.28

MA1, speclflcally meLhadone and buprenorphlne, save slgnlflcanLly more money Lhan oLher forms of LreaLmenL. MeLhadone and buprenorphlne are only used Lo LreaL oplaLe use dlsorders, and Lhelr effecLlveness ln lowerlng boLh crlmlnal acLlvlLy and llllclL drug use has been well documenLed across sLudles conducLed ln Lhe unlLed SLaLes and abroad. 1he unlLed naLlons Cfflce of urug use and Crlme lndlcaLes LhaL each dollar spenL on meLhadone malnLenance ylelds a cosL savlng ln Lerms of crlme reducLlon beLween $4 and $7. When healLh care cosLs are lncluded, Lhe beneflLs reLurned are $12 for each $1 lnvesLed.29

CurrenLly Lhe Llme llmlLs on buprenorphlne and Lhe lack of meLhadone coverage under Medlcald have dlsasLrous consequences for llllnolsans. llllnols's llfeLlme llmlLs of [usL one year on buprenorphlne malnLenance are Lhe mosL resLrlcLlve ln Lhe naLlon.30 1lme ln LreaLmenL does maLLer, as some of Lhe beneflLs of MA1 are Llme relaLed. lor example, researchers have found an over 70 decllne ln crlmlnal acLlvlLles wlLhln Lhe flrsL four monLhs of meLhadone malnLenance LreaLmenL.31 CrlmlnallLy decreased slgnlflcanLly for each year Lhe lndlvldual sLayed ln LreaLmenL, sLablllzlng aL year 6. ln facL, across all LreaLmenL modallLles, Llme ln LreaLmenL" ls Lhe blggesL predlcLor of good ouLcomes lncludlng absLlnence and crlme reducLlon.32 Add|t|ona| 8enef|ts of MA1 - nIV and nCV keduct|onsMany sLaLes are now seelng Lhe lncldence of Plv lnfecLlons rlse among Lhose who ln[ecL drugs. 1hls ls a slgnlflcanL concern, especlally among Lhe newer lnlLlaLes Lo heroln, who are more llkely Lo ln[ecL drugs Lhan older cohorLs.33 MeLhadone and buprenorphlne reduce Lhe lncldence of blood-borne paLhogen lnfecLlons by decreaslng Lhe frequency of ln[ecLlon and sharlng pracLlces.34 ConslsLenL drug LreaLmenL plays a slgnlflcanL role ln overall harm reducLlon pracLlces. urug use rlsk reducLlon ls more llkely Lo occur among lndlvlduals who remaln ln drug LreaLmenL, buL Lhose who dlsconLlnue LreaLmenL and Lhose who conLlnue Lo ln[ecL whlle ln LreaLmenL may also beneflL.33

19 1he beneflLs of provldlng meLhadone for [usL 2,300 people could save Lhe SLaLe abouL $82.3-$100 mllllon ln reduced crlme and healLh care consequences (lncludlng Lhe cosL of Lhe LreaLmenL). rovldlng more LreaLmenL, especlally oplold agonlsL Lheraples, could reduce Lhe prlson populaLlon among class 4 offenders alone by approxlmaLely 1,000 cases per year, based on analysls of Cook CounLy arresLee paLLerns and llllnols' prlson release sLaLlsLlcs ln 2013.36 Conslderlng Lhe sLaLe's dlre flscal clrcumsLance as well as Lhe Covernor's focus on crlmlnal [usLlce reform a helghLened focus on subsLance use LreaLmenL and expanded supporL for MA1 would seL llllnols on Lhe rlghL Lrack. SubsLance use LreaLmenL (especlally MA1) saves llllnols mllllons of dollars, reduces Lhe lncldence of blood-borne paLhogens llke Plv and PCv, Lakes a ma[or cuL ouL of llllnols's crlme raLe, and wlll reduce Lhe lmpacL LhaL Lhe heroln crlsls ls havlng on llllnols's clLlzens and Laxpayers. 20 CLIC kLCCMMLNDA1ICNS 1. Address the strongest r|sk factor for hero|n add|ct|on: Add|ct|on to prescr|pt|on op|o|d pa|nk|||ers. lL ls lmporLanL for famllles, lndlvlduals and docLors Lo undersLand LhaL prescrlpLlon oplold mlsuse can lead Lo heroln use.37lL ls essenLlal LhaL Lhose who are caughL mlsuslng prescrlpLlon oplolds be dlrecLed Lo medlcaLlon asslsLed LreaLmenL programs, whlch work very well for lndlvlduals wlLh oplold plll addlcLlon.CuLLlng Lhese lndlvlduals off from Lhe supply of oplolds - wlLhouL a connecLlon Lo LreaLmenL - ls a reclpe for "+4#)/$)0 heroln use. 2. Increase access to and tra|n|ng for adm|n|ster|ng na|oxone to reduce hero|n and other op|o|d overdose deaths. naloxone (narcan) ls a subsLance LhaL has been legal for non-medlcal persons Lo use ln llllnols slnce 2009, when Lhe Cverdose revenLlon AcL was slgned lnLo law. Peroln and oplaLe overdose deaLhs are prevenLable. 1housands of llves have been saved as a dlrecL resulL of Lralned laypersons uslng naloxone on an overdoslng person.38 8esearch shows LhaL when naloxone ls dlsLrlbuLed ln communlLles lL can reduce overdose deaLhs ln Lhose communlLles by 30 percenL.39 naloxone ls safe.40 naloxone ls as nonLoxlc as waLer and has no poLenLlal for addlcLlon. naloxone does noL have any effecL on a person LhaL has noL used heroln or oLher oplaLes. naloxone dlsLrlbuLlon has been endorsed by Lhe Amerlcan Medlcal AssoclaLlon, Lhe SubsLance Abuse and MenLal PealLh Servlces AdmlnlsLraLlon (SAMPSA), Lhe naLlonal lnsLlLuLe on urug Abuse (nluA) and many oLhers. naloxone ls also cosL effecLlve.41 lL cosLs beLween $20-$40 dollars for a full naloxone klL, whlch lncludes everyLhlng a person would need Lo reverse an overdose.42Money spenL dlsLrlbuLlng naloxone provldes Lremendous value for every dollar spenL. An overdose deaLh by comparlson cosLs Laxpayers abouL $30,000.43 ln llllnols, anyone can be Lralned Lo admlnlsLer naloxone. lamlly, frlends, flrsL responders - all laypeople - can be LaughL Lo recognlze an overdose and admlnlsLer naloxone durlng an overdose emergency. llllnols has a law LhaL allows for laypersons Lo use Lhls llfesavlng drug. lncreaslng naloxone access can be achleved ln a number of ways: LeglslaLlon has passed boLh houses LhaL would allow pharmaclsLs Lo lnlLlaLe naloxone prescrlblng, Lhus maklng Lhe drug more avallable, ln areas where law enforcemenL are Lhe flrsL respondersLo an overdose lncldenL, lL ls essenLlal LhaL Lhey are Lralned and have access Lo Lhls llfe savlng drug, uocLors who are prescrlblng prescrlpLlon oplold pllls should always co-prescrlbe naloxone, 1reaLmenL agencles should Lraln Lhelr paLlenLs ln Lhe use of naloxone, and paLlenLs should leave LreaLmenL wlLh an overdose prevenLlon plan ln place and naloxone ln hand, slnce an lndlvldual faces Lhe greaLesL chance of dylng from an overdose when he or she loses Lolerance Lo heroln or oLher oplolds.aLlenLs need Lo undersLand Lhese rlsks so LhaL a LreaLmenL lapse does noL end ln deaLh, 1he SLaLe of llllnols should lnvesL fundlng ln exlsLlng naloxone programs slnce, as lndlcaLed above, naloxone klLs are slgnlflcanLly cheaper Lhan an overdose deaLh abouL $23-$40 and $30,000, respecLlvely. 21 3. Lnsure that a|| med|cat|on ass|sted treatment (MA1) |s covered by Med|ca|d, w|thout t|me ||m|ts.MA1, speclflcally meLhadone and buprenorphlne, save slgnlflcanLly more money Lhan oLher forms of LreaLmenL. MeLhadone and buprenorphlne are only used Lo LreaL oplaLe use dlsorders, and Lhelr effecLlveness ln lowerlng boLh crlmlnal acLlvlLy and llllclL drug use has been well documenLed across sLudles conducLed ln Lhe unlLed SLaLes and abroad. 1he unlLed naLlons Cfflce of urug use and Crlme lndlcaLes LhaL each dollar spenL on meLhadone malnLenance ylelds a cosL savlng ln Lerms of crlme reducLlon beLween $4 and $7. When healLh care cosLs are lncluded, Lhe beneflLs reLurned are $12 for each $1 lnvesLed44.CurrenLly, Lhe Llme llmlLs on buprenorphlne and Lhe lack of meLhadone coverage under Medlcald have dlsasLrous consequences for llllnolsans. llllnols's llfeLlme llmlLs of [usL one year on buprenorphlne malnLenance are Lhe mosL resLrlcLlve ln Lhe naLlon. 1lme ln LreaLmenL does maLLer, as some of Lhe beneflLs of MA1 are Llme relaLed. lor example, researchers have found an over 70 decllne ln crlmlnal acLlvlLles wlLhln Lhe flrsL four monLhs of meLhadone malnLenance LreaLmenL.43 CrlmlnallLy decreased slgnlflcanLly for each year Lhe lndlvldual sLayed ln LreaLmenL, sLablllzlng aL year slx. ln facL, across all LreaLmenL modallLles, Llme ln LreaLmenL" ls Lhe blggesL predlcLor of good ouLcomes lncludlng absLlnence and crlme reducLlon.46 rovldlng meLhadone for [usL 2,300 people could save Lhe SLaLe of llllnols abouL $82.3-$100 mllllon ln reduced crlme and healLh care consequences (lncludlng Lhe cosL of Lhe LreaLmenL).47

4. Lnsure that state funded drug courts are fo||ow|ng ev|dence based pract|ces as |s requ|red w|th federa||y funded drug courts, espec|a||y the |nc|us|on of MA1. ln keeplng wlLh evldenced based pracLlces, Lhe unlLed SLaLes ueparLmenL of !usLlce wlll noL fund drug courLs LhaL prohlblL or deny any parLlclpanL Lhe use of medlcaLlon asslsLed LreaLmenL for a subsLance use dlsorder, llke meLhadone and buprenorphlne.48ln order for llllnols's drug courLs Lo besL serve Lhelr parLlclpanLs, Lhe federal model musL be applled aL Lhe sLaLe level. llllnols drug courLs seeklng sLaLe fundlng should noL deny parLlclpanLs access Lo Lhe program based on Lhelr use of medlcaLlons for oplaLe and heroln use dlsorders. 1hls approach ensures LhaL more llllnolsans ln need are able Lo make use of Lhe sLaLe's drug courL program, and also saves a greaL deal of money slnce each dollar lnvesLed ln meLhadone saves Laxpayers $12 ln reduced healLh care and crlme cosLs. S. Lxpand access to MA1 |n county [a||s and state pr|sons and strengthen ||nkages between correct|ona| fac|||t|es and MA1 prov|ders. As has been dlscussed, medlcaLlon asslsLed LreaLmenL (MA1) saves llllnols Laxpayers mllllons of dollars, and has been proven effecLlve ln LreaLlng oplold and heroln use dlsorders. MA1 ls especlally lmporLanL ln [alls and prlsons, where lL has been llnked Lo decreases ln recldlvlsm and drug-relaLed dlseases, lncludlng blood borne paLhogens llke Plv and PepaLlLls C.49 Some correcLlonal sysLems, alLhough noL ln llllnols, currenLly supply lndlvlduals wlLh buprenorphlne, meLhadone or vlvlLrol l (long acLlng nalLrexone, an oplold anLagonlsL). Powever, vlvlLrol ls noL nearly as well-researched as meLhadone or buprenorphlne, slnce lL was only approved by Lhe luA ln 2010.30 ln order for llllnols [alls and prlsons Lo geL Lhe mosL ouL of MA1, Lhey musL provlde all forms of medlcaLlons for addlcLlon LreaLmenL Lo lncarceraLed and/or deLalned lndlvlduals, and llnk Lhem Lo MA1 servlces ouLslde of [all or prlson. lndeed, research suggesLs LhaL formerly lncarceraLed people who conLlnued MA1 upon release were, slx monLhs laLer, more llkely 22 Lo be ln LreaLmenL and be heroln-free Lhan Lhose who recelved counsellng alone.31 Lxpandlng access Lo MA1 ln [alls and prlsons and llnklng prlsoners wlLh subsLance use dlsorders Lo MA1 ouLslde correcLlonal faclllLles wlll reduce llllnols's prlson populaLlon, reduce recldlvlsm, prevenL Lhe spread of drug-relaLed dlseases, and save Lhe sLaLe mllllons of dollars ln crlme and healLh care cosLs. 6. Increase the ava||ab|||ty of syr|nges and know|edge of syr|nge access |aws and harm reduct|on pract|ces |n I|||no|s.lncreases ln ln[ecLlon drug use across Lhe sLaLe, parLlcularly ln areas LhaL have hlsLorlcally noL had a large ln[ecLlon drug uslng populaLlon, should be counLered by lnLervenLlons Lo prevenL lndlvlduals from conLracLlng blood-borne paLhogens and experlenclng oLher healLh problems assoclaLed wlLh ln[ecLlon drug use. 1he rlsk of conLracLlng PepaLlLls 8, PepaLlLls C or Plv lncreases when lndlvlduals do noL have clean equlpmenL each Llme Lhey ln[ecL a subsLance.32 Added Lo Lhese healLh rlsks are oLher lllnesses such as coLLon fever", abscesses and oLher lnfecLlons LhaL may occur because of uslng old, used or lmproper ln[ecLlon equlpmenL.33 lndlvlduals LhaL ln[ecL subsLances should be lnformed of Lhe poLenLlal healLh rlsks assoclaLed wlLh Lhelr ln[ecLlon drug use and be glven guldellnes Lo help Lhem mlnlmlze Lhese rlsks. LducaLlon campalgns, ln con[uncLlon wlLh provldlng sLerlle ln[ecLlon equlpmenL Lo lndlvlduals, wlll greaLly reduce Lhe healLh rlsks of ln[ecLlon drug use. 7. Increase state funded treatment capac|ty for |nd|v|dua|s w|th hero|n or op|ate use d|sorders. 1he decrease ln sLaLe funded LreaLmenL ls maklng Lhe heroln crlsls worse.CurrenLly, marl[uana LreaLmenL admlsslons, referred by Lhe crlmlnal [usLlce sysLem, Lake up abouL 13 of LoLal LreaLmenL capaclLy ln llllnols.34 Conslderlng Lhe connecLlons beLween oplold and heroln use dlsorders and acqulslLlve crlmes such as LhefL, Lhe rlsk of overdose, and Lhe rlsk of acqulrlng blood borne paLhogens, a large percenLage of LreaLmenL should be seL aslde for lndlvlduals wlLh oplold and heroln use dlsorders, LreaLmenL capaclLy Lhrough sLaLe funded sysLems should be lncreased for Lhls populaLlon. 8. Improve data co||ect|on around hero|n and op|o|d |nd|cators. 1here ls a lack of lnLegraLed daLa collecLlon ln llllnols for heroln and oplold lndlcaLors.A sysLem needs Lo be seL up Lo more accuraLely capLure Lhe number of non-faLal and faLal overdoses. uaLa collecLlon provldes a sysLemaLlc way of plnpolnLlng areas where heroln and oplold use dlsorders are lncreaslng. 1hese daLa can be uLlllzed for Lhe followlng purposes LhaL would help reduce Lhe oplold crlsls ln llllnols: 1)ueLermlnlng Lhe need vs avallablllLy of MedlcaLlon AsslsLed 1reaLmenL (MA1), 2)lncreaslng access Lo naloxone ln areas whlch show paLLerns of non-faLal and faLal overdoses, 3)lncreaslng syrlnge dlsLrlbuLlon and llnkage Lo oLher servlces llke MA1 and naloxone access, 4)8eLLer assessmenL of wheLher faLal overdoses are caused by prescrlpLlon oplolds or heroln, slnce heroln overdoses are generally undercounLed. 1here ls pendlng leglslaLlon LhaL addresses mosL of Lhese lssues lncludlng focus on LreaLmenL parlLy, access Lo LreaLmenL, naloxone expanslon, lmproved daLa collecLlon, and lncreased heroln and oplold educaLlon. 1he Peroln Crlsls AcL would address mosL lf noL all of Lhese lssues, and should be consldered as a sLep forward ln curblng Lhe llllnols heroln and oplold epldemlc. 23 ALNDIk A 1reatment Lp|sode Data Set (1LDS) Ana|ys|s 1ab|e A.1 ercenL of SLaLe lunded 1reaLmenL Admlsslons for all SubsLances ln SelecLed llllnols MeLro and 8ural Areas (2007 vs 2012) earA|coho|Coca|neMar|[uananero|nMethA|| Cther Drugs 8|oom|ngton-Norma| 2007291644S13 20123373611212 Champa|gn-Urbana 2007462217627 20123110361338 Decatur Metro 2007412920333 20124017923210 eor|a-ek|n 2007481719718 20123992316212 kockford Metro 20073313242403 2012299282409 Metro Last 2007322330436 201227103218310 Spr|ngf|e|d Metro 2007382721824 2012289391239 kura| 2007461228373 2012416277713 1ab|e A.2 ercenL Change ln roporLlon of SLaLe lunded 1reaLmenL Admlsslons for Peroln ln SelecLed llllnols MeLro and 8ural Areas (2007 - 2012) A|coho|Coca|neMar|[uananero|nMethA|| Cther Drugs 8|oom|ngton-Norma|12-37-1811628164 Champa|gn-Urbana-34-3611211S2413 Ch|cago Metro7-463144184 Decatur Metro-3-42-33S60-32226 eor|a-ek|n-18-30201193333 kockford Metro-13-37183-3106 Metro Last-16-62931S-863 Spr|ngf|e|d Metro-26-67874940114 kura|-12-33-31S80179 State of I|||no|s1-3020716129 24 I|gure A.1 1oLal llllnols 8aLe ln 1reaLmenL Admlsslons per 100,000 (2000-2012) 0.0 100.0 200.0 300.0 400.0 300.0 600.0 700.0 800.0 2000200120022003200420032006200720082009201020112012 1ota| I|||no|s kate 1reatment Adm|ss|ons per 100,000 (2000 - 2012)